NHA CBCS Exam Prep Questions & Answers 2023/2024
What actions should be taken when a claim is billed for a level four office visit and paid at a level three? - ANSWER-Submit an appeal with documentation
The standard medical abbreviation "ECG" refers to a test used to assess which of the bod...
What actions should be taken when a claim is billed for a level four office visit and paid at a level three? -
ANSWER-Submit an appeal with documentation
The standard medical abbreviation "ECG" refers to a test used to assess which of the body systems? -
ANSWER-cardiovascular system- test checks electricity of heart
According to HIPAA standards, what identifies the rendering provider on the CMS-1500 claim form in
Block 24J? - ANSWER-NPI
On the CMS-1500 claim form, blocks 14 through 33 contain information about? - ANSWER-The patient's
condition and the provider's information
Which block should the BCS complete on the CMS-1500 form for procedures, services, or supplies? -
ANSWER-24D
Which term describes when a plan pays 70% of the allowed and the patient pays 30%? - ANSWER-
Coinsurance is a percentage of the cost for covered services that is approved by the insurance company
A provider charges $500 to a claim that had an allowable amount of $400. What should happen to the
non-allowed charge? - ANSWER-Write Off or adjustment
Patient: Justin Austin; Social Security NO.: 555-22-1111; Medicare ID NO.: 555-33-2222A; DOB:
05/22/1945. Claim information entered: Austin, Jane; Social Security No.: 555-22-111; Medicare ID No.:
555-33-2222A; DOB: 052245. What is a reason the claim was rejected? - ANSWER-The DOB is entered
incorrectly - the format is two digits for the month and four digits for the year.
A patient's health plan is referred to as the "payer of last resort." The patient is covered by which health
plan? - ANSWER-Medicaid
, The physician bills $500 to a patient. After submitting the claim to the insurance company, the claim is
sent back with no payment. The patient still owes $500 for the year. This amount is called what? -
ANSWER-Deductible
Ambulatory surgery centers, home health care, and hospice organizations use what form? - ANSWER-UB-
04 Form
A physician ordered a comprehensive metabolic panel for a 70-year-old patient who has Medicare as her
primary insurance. Which form is required so the patient knows she may be responsible for payment? -
ANSWER-Advanced Beneficiary Notice is a form that is required for Medicare recipients
Which of the following should the BCS complete to be reimbursed for the provider's services? -
ANSWER-CMS-1500 claim form
What is the maximum number of diagnoses that can be reported on the CMS-1500 claim form before a
further claim is required? - ANSWER-12
Describe a delinquent claim? - ANSWER-It is considered delinquent when it is overdue for payment, 120
days or older
What are considered proper supportive documentation for reporting CPT and ICD codes for surgical
procedures? - ANSWER-Operative reports are required to support surgical procedures
When submitting a clean claim with a diagnosis of kidney stones, which of the following procedure
names is correct? - ANSWER-Nephrolithiasis The destruction of kidney stones
The BCS should first divide the e/m code by which of the following? - ANSWER-Place of service which
narrows down the specific code as one of the three deciding factors
Appeal the decision with a provider's report - ANSWER-Which of the following actions should be taken if
an insurance company denies a service as not medically necessary?
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